Acute kidney injury (AKI), a sudden reduction in kidney function, is seen in some people with covid-19 infection. A subset of patients develops severe AKI and need renal replacement therapy (RRT). As in many settings, the event of AKI is related to an increased risk of mortality. Although our understanding is incomplete, an image is emerging from case reports and autopsy series of covid-19 specific causes of AKI. Intrinsic renal pathology including thrombotic vascular processes, viral mediated tubular cell injury, and glomerulonephritis are reported, also as AKI resulting from extrinsic factors like fluid depletion, multi-organ failure, and rhabdomyolysis. Anecdotal reports have emerged of proximal tubular injury with Fanconi syndrome that manifests as hypokalaemia, hypophosphataemia, normal anion gap acidosis , and hypovolaemia from salt wasting. Importantly, AKI can occur in the least stages of covid-19 infection, so clinical vigilance and consideration of risk factors for AKI alongside early detection and diagnosis are essential components of general supportive care. Fluid management is central to the present.
